Female Infertility
Most fertile couple could conceive within a 12 months of regular
unprotected sex. Of course, you may still become pregnant naturally,
but it would be wise to seek advice.
To achieve pregnancy you must ovulate, have at least one
functioning patent fallopian tube, produce watery mucus by the cervix
near the time of ovulation that permits the ejaculated sperm to pass
into the uterus from the vagina, and have a healthy womb with good
lining (endometrium) that permits implantation of the embryo.
At the beginning of the menstrual cycle the pituitary gland in your
brain releases a follicle-stimulating hormone (FSH), which stimulates
the ovary to produce follicles. One of these follicles grows faster to
become the "dominant follicle". It is from this follicle that the egg
will be released.
The follicles produce oestrogen which promotes development of the
endometrium and progesterone, released after ovulation, which prepares
the endometrium for pregnancy.
When the egg is released, it is picked by the fallopian tube and
then fertilised in the outer third of the tube. The fertilised egg
continues to the uterus to implant in the lining (endometruim)
resulting in a pregnancy. If pregnancy does not take place, the
endometium is shed as a menstrual period approximately 14 days after
ovulation.
Common Causes of Infertility in the Female
Ovulatory disorders
Ovulatory disorders occur as a result of hormonal imbalance either
within the hypothalamus, the pituitary or in the ovaries. Common causes
include stress, excessive changes in body weight and polycystic
ovaries. Polycystic ovaries (POC) can affect up to 30% of women with
infertility problems. The ovaries contain many tiny cysts, and women
with PCO may experience menstrual irregularities, fertility problems,
excessive body hair, acne and obesity. Treatment usually involves
ovulation induction ± intra-uterine insemination (IUI). Laparoscopic
ovarian drilling using diathermy or laser is an alternative treatment
option.
Fallopian Tube Blockage
Fallopian Tube Blockage may occur as a result of a previous
infection or abdominal surgery complicated by adhesions. Accumulation
of fluid in the tube (hydrosalpinx) may also become a source of chronic
infection and inhibit fertility. Although some blockages may be treated
surgically, IVF is often the best option.
Endometriosis
Endometriosis is a condition where the tissue, which normally lines
the uterus, is found at other sites in the pelvis. Bleeding occurs from
these tissues at the time of menstruation causing pelvic pain and
painful periods. Blood filled cysts may develop within the ovaries,
causing pelvic scarring that affects the fallopian tubes and leads to
infertility.
Treatment of endometriosis for infertility is surgical often key
hole but recurrence of is common. IVF is a more appropriate treatment
for most of the patients with endometriosis-induced infertility.
Unexplained Infertility
Unexplained infertility affects up to 25% of infertile couples. It
is not always possible to determine if the eggs are actually released
from the follicles, if the fallopian tubes are functioning or if the
sperm is capable of fertilising the egg. Intrauterine insemination
(IUI) offers a simple relatively non-invasive procedure. If pregnancy
does not occur within three IUI cycles, alternative methods such as IVF
± ICSI should be considered.
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